How do I choose the right health insurance plan?

Start by considering your healthcare needs, budget, preferred doctors, prescription medications, and how often you expect to use medical care. Then compare each plan's premiums, deductible, copays, coinsurance, out-of-pocket maximum, and provider network.

What's the difference between a health plan type and a metal tier?

A health plan type, such as an HMO, PPO, EPO, or POS, describes how you access healthcare and use a plan's provider network. A metal tier, such as Bronze, Silver, Gold, or Platinum, describes how you and your insurance company generally split the cost of covered healthcare services.

What is the difference between an HMO and a PPO?

The main difference is flexibility. HMO plans typically require you to use in-network providers and may require referrals to see specialists. PPO plans generally let you see both in-network and out-of-network providers and don't usually require referrals, but you'll typically pay more for that flexibility.

What is a good deductible for health insurance?

There isn't one deductible that's best for everyone. A good deductible depends on your healthcare needs, budget, and how much you can comfortably afford to pay out of pocket.

Is it better to have a lower deductible or lower premium?

Plans with lower deductibles generally have higher monthly premiums, while plans with higher deductibles typically have lower monthly premiums. If you expect frequent medical care, paying more each month for a lower deductible may make sense. If you rarely need care, a lower premium and higher deductible could save you money overall.

Does my deductible reset every year?

Generally, yes. Most health insurance deductibles reset at the beginning of each new plan year. Once the new plan year begins, you'll typically need to meet your deductible again before your plan starts paying its share of covered services. However, the exact reset date and rules can vary by plan, so check your plan documents to confirm.

What happens if I don't meet my health insurance deductible?

If you don't meet your deductible during the plan year, you'll generally pay the full cost of covered services that are subject to the deductible.

Do copays count toward my deductible?

Usually, no. Copayments generally don't count toward your deductible, although they may count toward your out-of-pocket maximum.

Can an HRA reimburse my health insurance deductible?

Yes. An employer-sponsored health reimbursement arrangement (HRA) can reimburse eligible deductible expenses if the employer includes them in the HRA's plan design.

Can an HRA help employees pay for health insurance premiums?

Yes. Depending on the type of HRA, employers can let employees use their tax-free allowance to pay for individual health insurance premiums. ICHRAs and QSEHRAs can reimburse eligible individual health insurance premiums, while GCHRAs generally don't cover insurance premiums.

Do employees pay taxes on HRA contributions?

Generally, no. Employees don't pay taxes on reimbursements for eligible medical expenses when they meet the HRA's requirements.

What's the difference between an ICHRA, QSEHRA, and GCHRA?

The right HRA depends on your organization's size, existing benefits, and goals. An ICHRA works for employers of any size and lets them vary allowances based on employee class. A QSEHRA works for employers with fewer than 50 full-time equivalent employees and comes with annual contribution limits. A GCHRA supplements an existing group health plan by helping employees pay for eligible out-of-pocket medical expenses.

Do startups have to offer health insurance?

Startups aren’t always required to offer health insurance. However, applicable large employers (ALEs) with 50 or more full-time equivalent employees (FTEs) must comply with the Affordable Care Act (ACA) employer mandate. Even when health coverage isn't required, offering a health benefit can help startups attract and retain employees.

What is the best health insurance for startups?

The best health insurance option for a startup depends on factors like company size, budget, and employee needs. Traditional group health insurance is one option, but many startups choose health reimbursement arrangements (HRAs), such as an individual coverage HRA (ICHRA) or qualified small employer HRA (QSEHRA), because they offer greater flexibility and predictable costs.

Is an ICHRA or QSEHRA better for startups?

The right choice depends on your startup's size, growth plans, and benefits goals. An ICHRA is available to employers of all sizes and offers more flexibility, including no annual contribution limits and customizable employee eligibility options. A QSEHRA is only for small businesses with fewer than 50 full-time equivalent employees (FTEs) and has annual contribution limits set by the IRS.

Can you use an HRA to pay for an HMO plan?

Yes. If your employer offers a stand-alone health reimbursement arrangement (HRA), such as an individual coverage HRA (ICHRA) or qualified small employer HRA (QSEHRA), you can receive tax-free reimbursements for eligible individual health insurance premiums, including HMO plan premiums. You’ll need to provide proof of coverage and other required documentation to receive reimbursement.

Is an HMO plan better than a PPO plan?

It depends on your healthcare needs and priorities. HMO plans typically have lower premiums and out-of-pocket costs but require you to use a specific network of providers and get referrals for specialist care. PPO plans usually cost more but offer greater flexibility when choosing doctors and accessing out-of-network care.

Are HMO plans available on the health insurance marketplace?

Yes. Many insurance companies offer HMO plans through the individual health insurance market, including plans available through the Health Insurance Marketplace. Availability, costs, and provider networks vary by location, so it’s important to compare your options based on your healthcare needs and budget.

Can an employee use a Section 125 plan and an ICHRA together?

Yes, but only if the employee purchases an individual health insurance policy on an off-exchange marketplace.

Can a Section 125 plan pay for individual health insurance premiums?

Yes. A Section 125 premium-only plan can pay for individual premiums under specific conditions. When paired with an ICHRA, only pre-tax payroll deductions can go toward premiums for eligible off-exchange individual health insurance plans. Employees who enroll in an on-exchange plan through a public exchange, like the federal Health Insurance Marketplace or a state exchange, can't use a Section 125 cafeteria plan to pay for the portion of their premium that their ICHRA allowance doesn't cover.

Why don’t on-exchange health plans work with a Section 125 plan?

Because public exchanges already offer premium tax credits and other cost-sharing subsidies, federal law prohibits employees from using pre-tax salary reductions under a Section 125 cafeteria plan to pay on-exchange health insurance premiums. This prevents "double-dipping" tax advantages.

Can an ICHRA reimburse an employee’s entire health insurance premium payment?

This depends on the cost of the plan and the employer’s ICHRA allowance. Employers choose a set monthly allowance amount. If an employee's premium exceeds that allowance, they must pay the remaining balance unless they have access to another eligible payment method. If the plan’s cost is less than their allowance, then the ICHRA is essentially reimbursing the employee’s entire premium cost.

Can employers offer different ICHRA allowance amounts to different employees?

Yes. Employers can vary reimbursement amounts using eligible employee classes — such as full-time vs. part-time workers and salaried vs. hourly employees — as long as they adhere to federal ICHRA regulations and nondiscrimination rules. Within each class, they can also vary contributions by employee age and family size.

Does PeopleKeep administer Section 125 plans with an ICHRA?

No. PeopleKeep uses a reimbursement-based ICHRA model and therefore doesn't offer Section 125 premium-only payroll deductions. However, organizations that need this capability can do so with our parent company, Remodel Health. Contact Remodel Health or us to learn more about how our ICHRA administration solutions compare.

When is Open Enrollment for 2027 health insurance coverage?

For most states that use HealthCare.gov, OE is expected to begin on November 1, 2026, and end on January 15, 2027. Some state-based Marketplaces have different enrollment periods, so check your state's official Marketplace for its current deadlines. It's also important to note that OE rules remain subject to ongoing litigation. A proposed federal rule that would have shortened the enrollment period was vacated by a federal court in June 2026 and is currently being appealed. As a result, enrollment deadlines could still change.

Which states have extended Open Enrollment periods?

Several state-based Marketplaces extend OE beyond the standard federal timeline, giving residents additional time to enroll in or change their health coverage. Those states include: California D.C. Massachusetts New Jersey New York Because enrollment dates can change from year to year, always verify your state's OE schedule through its official Marketplace website before enrolling.

What happens if I miss Open Enrollment?

If you miss OE, you may still be able to enroll in health coverage if you qualify for a special enrollment period (SEP). Common qualifying life events include: Losing employer-sponsored health coverage Getting married Having or adopting a child Moving to a new state or ZIP code Becoming eligible for an individual coverage HRA (ICHRA) or a qualified small employer HRA (QSEHRA) If you don't qualify for an SEP, you'll generally need to wait until the next Open Enrollment Period to enroll in Marketplace coverage.